SIFTING THROUGH GRISLY AUTOPSY reports on abused, murdered children, Arizona Republic reporter Karina Bland was transfixed by a Polaroid photo. It was stapled to a police file labeled ``Ashley Guerard, 8 months,'' and showed a tiny pink coffin. Bland made a mental note to describe it in her copy as ``the size of a dresser drawer.'' The image wouldn't rest until publication, though. It repeatedly surfaced in dreams, in which Bland would spot the doll-sized coffin at her office, in a convenience store, or nestled among her belongings in a drawer at home. ``It was horrible. It was so real,'' Bland says of the dreams. So were more sleep-halting nightmares about young children burned, beaten and sexually defiled. During the four-month investigation leading to ``What Happens When Adults Kill Kids,'' an award-winning 1997 package, the reporter developed constant nausea and lost 15 pounds. At first she tried coping by ``getting loaded on beer'' with a neighbor sympathetic to her rage over lenient sentences for child killers. But the nightmares continued. Finally, Bland turned to a crisis counselor. ``I was so embarrassed,'' she confesses. ``I didn't even tell anybody for the longest time.'' Her editor was one of the few people in whom she confided in the newsroom. There, ``nobody talks about this stuff. We interview people about trauma and we see horrible things all the time, but we never consider how it affects us.'' Bland's experience points up the dilemma for journalists confronting horror, whether in police files, on highways or at house fires, at the bombed ruins of a federal building, or in Rwandan streets red with blood. Though such coverage can create immense psychological stress, the standard newsroom script calls for stoicism. Admitting to emotional fall-out collides with the detached, dispassionate demeanor on which the profession prides itself. ``Some people do shy away from this issue and pooh-pooh it,'' acknowledges Chris Cramer, president of CNN's international news division. ``They fear being exiled as some kind of a wimp.'' The toll from chronicling human suffering is ``one of the things I always dreaded talking about,'' admits Rick Bragg, a Pulitzer Prize-winning New York Times reporter who has covered the Oklahoma City bombing and other ghastly episodes of American life. For those in the newsgathering business, seeking professional help can be perilous. Some journalists who have covered gruesome stories say they fear that admitting to any mental distress may be viewed as weakness. It may even spark editors to pull them off important projects or move them to ``softer'' assignments. But ignoring the trauma doesn't make it go away, as Bland learned. Nightmares, flashbacks and obsessive images are the normal consequences of witnessing horror, health experts say. Their research shows the effects of stress can be cumulative; denying or ``stuffing'' the aftermath of trauma can turn minds into time bombs. Some news operations have begun addressing the shocks their staffers face on the job (see ``Working Through the Anguish,''). Cramer, while head of newsgathering for the British Broadcasting Corp. in London, helped launch debriefing programs for journalists handling high-risk assignments. Select TV stations and newspapers have brought mental health pros right into the newsroom following a catastrophe. Still other companies discreetly direct their employees to therapy. Journalists seeking professional treatment first must wrestle with an entrenched macho culture. Those unwilling to do so look for other ways to cope.

MEDIA SCHOLAR CLEVE WILHOIT likens journalists to World War II veterans. ``They are just beginning to talk'' about their feelings relating to trauma, the Indiana University professor says. ``The acceptance of the fact of their own emotional involvement seems to be very difficult for them.'' Journalists--along with combat soldiers, police officers, firefighters and emergency medical teams--can be at risk for stress symptoms and even post-traumatic stress disorder by virtue of the awful things they see. There is one major difference, though. Of these groups, all but the media usually receive special instruction for dealing with traumatic events, say experts interviewed for this story. The others undergo mandatory debriefing for what has become known as ``critical incident stress.'' Despite training, some soldiers who fought in the Persian Gulf War suffered post-traumatic stress disorders. Why should journalists who document the carnage expect to be invulnerable? Among those professionals at the highest risk of stress, psychiatrist Frank Ochberg finds, surgeons and journalists have most strongly resisted outside help. ``Journalists, by habit or culture, refuse to feel their grief, their horror, their anxiety,'' says Ochberg, who helped develop a Michigan State University journalism program on how to cover trauma and its victims. Talk to reporters who have written about some aspect of horror, and Ochberg's assessment rings true. Most of the media professionals interviewed for this article had not sought debriefing after covering terrible events, even though counseling often was covered by employee assistance plans and, in some cases, psychologists were brought into the newsroom. Their main reasons: lack of time, especially in deadline reporting, and the strong belief of reporters that outsiders couldn't understand the rigors of being a witness on behalf of society. At the Baltimore Sun, ``we're offering counseling for anyone who wants it,'' says City Editor James Asher. Counselors are available through the company's employee assistance program. But few, if any, reporters have publicly acknowledged using the service. ``We had a reporter who was an official witness at an execution last night,'' Asher said in November. ``I asked her if she wanted to talk to a counselor about it, and she declined.'' Foreign correspondents, general assignment reporters and photographers face the greatest exposure to trauma, responding as they do to accidents, fires and other harrowing situations. ``The longer you're exposed to difficult things, the harder it is to deal with those things unless there is some formal support,'' says Roger Simpson, head of the Journalism and Trauma Program at the University of Washington in Seattle. That was the primary finding of his 1996 study of 131 journalists--editors, reporters and photographers from six papers in Michigan and Washington. The longer the exposure, the more likely a respondent had experienced avoidance tendencies and intrusive thoughts. Such symptoms were most prevalent among those who'd covered automobile crashes, says Simpson, an associate professor of journalism. Coverage of crashes and other emergencies often falls to rookies. To diminish the stress, the Journalism and Trauma Program aims to inoculate journalism students via role-playing and discussion. ``I guess it's like a vaccination,'' Simpson says. ``If you do this in the classroom, it may be somewhat easier at a crash.'' Some researchers theorize that reporters and photographers are potential secondary victims of trauma by the very function they perform. ``Their hearts are exposed even if they are looking through a lens,'' cautions Martin Cohen, a Florida psychologist who has worked with journalists at the Poynter Institute for Media Studies. ``They are injected with a poison, a certain kind of energy that can affect them for a long time if they don't deal with it. The mere exposure to trauma can be traumatic.'' The need for the media to click into another mode when recording horrific events, nudging aside normal human reactions, sometimes can trigger psychological reactions. Cohen recommends debriefing between 24 and 72 hours after exposure. During that critical period, he says, journalists have the best chance to squeeze the ``poison'' out of their systems. So some news organizations quickly set up intervention--especially when tragedy strikes at home. Hours after a bomb tore open Oklahoma City's Alfred P. Murrah Federal Building on April 19, 1995, killing 168 people, the Daily Oklahoman invited a counselor into its newsroom. And CBS affiliate KWTV offered group debriefing and individual counseling for its staff. Journalists' jobs at first were so demanding that they pushed their feelings aside, says Sue McMillon, KWTV's human resources manager. ``But by the fourth and fifth days, people were wearing thin. All that emotion hidden behind cameras and microphones surfaced.'' Approximately 35 journalists--almost all of those involved in the coverage--attended the station's first formal debriefing session at a nearby hotel. Follow-up counseling was offered at the station a month later and on the first anniversary of the blast.

RESEARCHERS POINT OUT THAT the media, in helping audiences see and feel human tragedy, must process information profoundly to convey it effectively. And that can spark greater emotional turmoil. ``Because I felt [the horror] so strongly, I wrote more graphically so people could feel it,'' says Bland, the Arizona Republic reporter. ``I had to go through the suffering and put myself in a pretty awful place to do that.'' ``You're not just an objective journalist doing your job,'' says psychologist Cohen, ``but a human being who has been exposed to something awful. To whatever degree the compassionate heart still works, there are going to be consequences for seeing someone else's suffering.'' Gordon Turnbull agrees. Director of a traumatic stress unit in London, the psychologist reminds his clients at the BBC that sensitive individuals cannot completely block horrendous recollections. The flashbacks and nightmares they're likely to suffer are, Turnbull says, ``part of a normal reaction in normal people.'' There are other repercussions. Studies show that people in high-risk professions--including journalism--are more prone to serious problems, from divorce to alcoholism or drug abuse. They're also more likely to suffer high blood pressure and heart attacks. Or worse. There is no way of knowing whether therapy could have saved Kevin Carter from the demons roaming his subconscious. The freelance photographer and South Africa native won a Pulitzer Prize in 1994 for his photograph of a vulture stalking a starving girl who'd collapsed on her way to a feeding station in southern Sudan. The image, published in the New York Times, became a metaphor for Africa's despair. Carter called the experience ``the most horrifying of my career.'' In July 1994, two months after collecting one of journalism's highest honors, the 33-year-old photojournalist's body was found by police in his red pickup truck near a Johannesburg suburb. He had died of carbon monoxide poisoning. ``The pain of his mission, to open the eyes of the world to so many of the issues and injustices that tore at his own soul, eventually got to him,'' his sister wrote in a letter to Time magazine. Carter's father told the South African Press Association that ``Kevin always carried around the horror of the work he did.'' Time magazine, in marking Carter's death, reported that after taking the picture, he ``sat under a tree, lit a cigarette, talked to God and cried.'' The article quoted one of the photographer's friends, freelance journalist Joao Silva: ``He was depressed afterward.... He kept saying he wanted to hug his daughter.'' Indeed, the Pulitzer came with a storm of criticism. ``The man adjusting his lens to take just the right frame of her suffering might just as well be a predator, another vulture on the scene,'' said a 1994 article in the St. Petersburg Times. In a suicide note left under his knapsack, Carter wrote: ``I'm really sorry. The pain of life overrides the joy to the point that joy does not exist.'' He also described being depressed and ``haunted by the vivid memories of killings and corpses and anger and pain...of starving or wounded children, of trigger-happy madmen.'' Afterward, James Nachtwey, a photographer for Magnum photo agency who often saw Carter on assignments, was quoted as saying: ``Every photographer who has been involved in these stories [of extreme human suffering] has been affected. You become changed forever. Nobody does this kind of work to make themselves feel good. It is very hard to continue.'' Some journalists, worn down by repugnant scenes, beg off of extremely stressful stories. After several years of covering corruption and murder in East St. Louis, Michael Sorkin asked his editors at the St. Louis Post-Dispatch not to tap him for any more ``blood stories.'' ``I wasn't asking for lighter assignments,'' says Sorkin, who won a 1993 award from Investigative Reporters & Editors for stories leading to the conviction of a corrupt city prosecutor. ``But never again do I want to go to a mother and ask for a photo of a dead child. I have seen enough blood for two lifetimes.'' Some journalists find comfort in the knowledge that their work instigates social change or brings about justice. ``If I get the story and I see that it has made a difference, I can sleep at night,'' says Newsday's Roy Gutman, who won a 1993 Pulitzer for exposing Serb-run concentration camps in Bosnia. ``What gives me sleepless nights, what could traumatize me, would be if I got a major part of the story wrong.'' Others who routinely cover violence try to creatively vent stress in their off hours. While on assignment for the Associated Press in Somalia and Iraq, combat photographer John Gaps wrote poetry. The descriptive verses, compiled in a journal, were ``a way of reminding myself how I felt about what I was seeing,'' Gaps says. Still, macabre details haunted him. In one case, it was the image of a silver watch on the wrist of a Serbian soldier whose head had been blown off by a rocket during the 1991 war in Croatia. ``His boots were still laced up, nice and tidy, and the watch was running,'' Gaps recalls. ``Those are the little things that take away your ability to reason later on.'' It was 12 years before the photographer felt the full measure of documenting blood and gore. Gaps suffered repeated anxiety attacks--unexpected and painful spasms in his chest. ``At first, I thought I was having a heart attack. I thought I was dying,'' he recalls. When the anxiety persisted, Gaps turned to a psychologist: ``She helped me learn to say, `Oops, here we go again. OK, I'm not dying. Just breathe and relax and ignore it.' '' Gaps assembled a collection of his poetry and photos--chronicling the suffering in Somalia, Iraq, Haiti and elsewhere--while recovering from a bullet wound inflicted in 1994 by a sniper in the Gaza Strip. The result was ``God Left Us Alone Here: A Book of War.'' Gaps describes the 1997 book, published by Lone Oaks Press, as ``my pressure relief valve.'' To divert herself from the horrors of covering genocide in Rwanda, Lindsey Hilsum redesigned the kitchen in her London apartment. ``That might sound heartless, but you have to find some way to stuff it aside a bit,'' explains the diplomatic correspondent for London's Channel 4 News. ``You lock it away in your head and do something else.'' Hilsum was one of few foreign journalists in the Rwandan capital of Kigali when the slaughter started in 1994. Working her way through roadblocks amid shelling and gunfire, Hilsum saw piles of dismembered bodies. During a visit to a local hospital, she watched a mother carry in a baby whose leg dangled by a single tendon. ``The gutters in the hospital were literally running with blood,'' she recalls. The reporter felt helpless, especially in the first flush of killings, when she fielded frantic phone calls from locals she had befriended. Gangs were coming to murder them, they said, and they begged her to save them. ``The worst thing is the fact that I didn't save anybody,'' Hilsum says. ``I felt if I put them in the car they'd be slaughtered at road blocks. I don't know. Maybe I should have tried, but I didn't.'' Nor has she since sought any psychological help for herself. ``What kind of counselor am I going to find in London--someone who doesn't even know where Rwanda is?'' Hilsum adds. ``The problem isn't me; it's not in my head. I have a right to be upset about this. It was an awful, dreadful thing I witnessed.''

UNSPOKEN BUT DE FACTO RESISTANCE to therapy was common after the Oklahoma City bombing, too. Though the Daily Oklahoman brought in a counselor, only two dozen reporters and photographers out of a newsroom staff of 150 participated in the initial crisis counseling. Over the weeks, their numbers dwindled to 10 or fewer. Counseling ``was a useful tool to have. I just wish more people who were up against the building, as I call it, would have used it,'' Managing Editor Ed Kelley says. Penny Owen was one of the front-line reporters who declined counseling. Thirty minutes after the blast, she watched mangled bodies being hauled out of the rubble in her hometown. She heard the screams and saw survivors' shocked faces. Afterward, she found it difficult to be alone at home, so she lingered in the newsroom. ``We did a lot of talking when we caught our breath,'' she says. Like many who experience trauma, Owen had a delayed reaction. ``I almost fell apart [on] the first anniversary,'' she says. ``I'm pretty tough; I'm not the whiny or emotional type, but this blindsided me.'' Covering the trials of Timothy McVeigh and Terry Nichols, who were convicted in connection with the bombing, was no easier. Owen shed tears as frightful details emerged. And, after particularly wrenching testimony on December 31, 1996, the reporter canceled her New Year's Eve plans, called a friend and wept. ``I was in an agitated state, almost a rage,'' Owen says. ``My reaction shocked me. It really did.'' Even then, she avoided professional help. ``I've never really been one who took advantage of counseling in a formal way,'' she says. Owen was concerned she'd come off as a victim, when ``there were so many real victims out there.'' Likewise, an aversion to victim status has kept the Times' Bragg from airing his feelings with a therapist. ``I never felt it was appropriate to whine,'' says the reporter, who went from covering the Oklahoma City bombing to a multiple murder in New Orleans. He also covered the 1998 murders of nine children by two classmates in Jonesboro, Arkansas. Journalists may be heartbroken by the misery they witness, but, Bragg says, ``We can't act like it or we can't get the job done.'' The face of a woman he met in Oklahoma City burns in his memory. She'd lost her husband, and ``that is real hurt,'' Bragg says. ``What's happened to us is something so much less. That doesn't mean what happens to us isn't serious. But I don't feel I have a right to call myself a victim. A good cop reporter sees far worse stuff than I do.'' Bragg has not taken advantage of the New York Times' counseling program. He will, he says, if he wakes up one day and feels a need to ``spill my guts.'' For Karina Bland, talking with a professional proved uplifting. Two sessions into counseling, the obsessive images began to fade. She attributes that to ``talking to an objective third person who didn't know me. It helped me gain new perspective.'' It also helped, Bland says, that her work prompted a public outcry and led Arizona to toughen its sentencing laws for child killers. Appearing on talk shows with some of the experts she'd interviewed provided more relief. ``That was so good for me,'' she says. ``It was no longer just my burden.'' Finally, her volunteer work for Big Brothers/Big Sisters has reminded her that ``there are healthy kids out there.'' Persuading media managers to promote intervention as a normal part of newsroom life might go a long way toward easing the resistance, says Cohen, the psychologist. ``The rank and file are not going to ask for it. They fear it would be interpreted as a weakness when, in fact, it is wisdom.'' The Daily Oklahoman's Ed Kelley needs no convincing. He strongly advocates a change in newsroom culture. ``We're taught in journalism school that this is a macho business, that you check your feelings at the door, that your personal emotions have nothing to do with it,'' the managing editor says. ``Unlike anybody else in this society, we're supposed to shut it all out. ``It's a myth. We can't do it.''

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